By Kerri Toloczko
What do you get when you combine $485 million in taxpayer benefits for Florida’s nonprofit hospitals and a dramatic rise in costs for Florida residents?
An investigation by Attorney General James Uthmeier, concerns from state lawmakers, and distrust by senior citizens like me who are paying more than ever out of pocket for care.
In June, Uthmeier launched a state investigation into hospital billing and transparency practices, issuing subpoenas to major systems including Southern Baptist Hospital of Florida and AdventHealth to determine whether they are complying with price disclosure and anti-deceptive practice laws. He described hospital billing practices as “predatory,” claiming that "the big health care industrial complex continues to rake in billions off Americans in their most vulnerable moments".
Lawmakers are also considering action. State senators have discussed expanding reporting requirements and bolstering enforcement mechanisms for hospitals’ price disclosures, noting that existing federal rules have broad noncompliance and limited penalties.
This scrutiny is critical, as it gives the public visibility into how nonprofit hospital’s deceptive practices are impacting patients.
Nonprofit hospitals receive substantial public subsidies—an estimated $1.7 billion in tax exemptions each year—in exchange for commitments to provide charity care, price transparency, and community health investment. Yet recent reviews of Internal Revenue Service filings and hospital cost reports show that nearly half of Florida’s 88 nonprofit hospitals spent less on community benefit than the value of the tax breaks they received between 2020 and 2022.
The result is an annual “fair share deficit” of roughly $485 million, with large systems such as Orlando Regional Medical Center among the biggest under-investors. Additionally, according to the latest Hospital Price Transparency Report, just 29% of hospitals in the state fully comply with the federal transparency rule that mandates published negotiated rates and cash prices, a drop from earlier this year. But even for those that meet the requirements, most disclosures do not include usable, dollars-and-cents prices that patients need to compare costs.
Hospital groups defend their practices, noting the complexity of healthcare pricing and the costs of delivering care, particularly for Medicaid and uninsured populations. Systems including AdventHealth and Baptist Health System Inc. highlight billions in charity care and community health programs in annual reports. But even so-called “transparency” leaves key information obscured.
When I was leading national nonprofits in the public policy space, one of our keys to success was to always advocate for transparency. Showing the sausage-making earns trust before you need it - and gives greater credibility when you are accused of wrongdoing. That’s especially true when the price of hospital services in the U.S. grew more than 250% between 2000 and 2024, outpacing general inflation by a wide margin and contributing significantly to rising health care spending.
For patients, these figures translate into fewer resources for community clinics, preventive care, and financial assistance programs that seniors and low-income Floridians rely on. Federal tax rules allow hospitals to count unpaid Medicaid shortfalls and administrative expenses as “community benefit,” which can make reports look generous while masking how much actual free or reduced-cost care patients receive. That accounting sleight of hand does nothing to help a retiree trying to understand why a routine hospital visit resulted in a four-figure bill.
Perhaps opacity was the goal to hide wrongdoing. In that case, Florida’s elected leaders are doing right by the public, especially the one in five citizens who are on Medicare and may not have the sophistication to navigate byzantine paperwork to know which hospitals are truly putting patients and their communities first.
If nonprofit hospitals are going to receive billions in tax advantages, they should be transparent, patient-centered, and worthy of that support. Being scrutinized for a lack of transparency or failure to adhere to grant statutes damages trust with patients, taxpayers, policymakers, and other key stakeholders is a bad look - and worse if it is proven that they are breaking the law.
Florida is a leader in many aspects of public policy, and its nonprofit hospitals have an opportunity to stake their claim as the benchmark for transparency and accountability. Let’s hope it is not squandered in a sea of continued opacity.
Kerri Toloczko is a resident of Naples, Florida and Chair of the Southwest Florida Center Right Coalition.
